Medicare Payment Integrity Investigator -Remote

This a Full Remote job, the offer is available from: United States WHAT WE CAN OFFER YOU: • Estimated Salary: $60,000 - $75,000, plus annual bonus opportunity • Benefits and Perks, 401(k) plan with a 2% company contribution and 6% company match. • Regular associates working 40 hours a week can earn up to 15 days of vacation each year. WHAT YOU'LL DO: • Act as a liaison with 3rd party vendors, including identifying data trends, validating rules, making recommendations for improvement, and providing updates to management. • Proactively seeks out and develops leads from a variety of sources (e.g., CMS, OIG, HFPP, NHCAA) • Perform evaluation of leads, complaints, and/or investigations. Conduct independent reviews resulting from the discovery of situations that potentially involve FWA, including communicating with medical providers and policyholders. • Develop appropriate recommendations and suggestions based on analysis and collaborate with management in the development of action plans where required. WHAT YOU’LL BRING: • Prior experience performing comprehensive reviews of Medicare healthcare claims to ensure accuracy, compliance with federal and state regulations, and alignment with contractual requirements. • Experience working with third-party vendors to identify data trends, validate coding rules, and recommend improvements that drive better outcomes. • Experience identifying and developing leads from trusted sources like CMS, OIG, HFPP, and NHCAA, evaluating them to uncover potential FWA cases. • In-depth knowledge of medical coding, billing practices, and healthcare regulations. In-depth understanding of ICD, CPT, HCPCS, DRG, revenue codes, NDC’s and other guidelines and general understanding of investigative processes within a healthcare environment are required. • You promote a culture of diversity and inclusion, value different ideas and opinions, and listen courageously, remaining curious in all that you do. • Able to work remotely with access to a high-speed internet connection and located in the United States or Puerto Rico. PREFERRED: We value diverse experience, skills, and passion for innovation. If your experience aligns with the listed requirements, please apply! If you have questions about your application or the hiring process, email our Talent Acquisition area at [email protected]. Please allow at least one week from time of applying if you are checking on the status. #Circa This offer from "Mutual of Omaha" has been enriched by Jobgether.com and got a 72% flex score. Apply tot his job